title: Diagnostic performance of computed tomography coronary angiography to detect and exclude left main and/or three-vessel coronary artery disease.
abstract: OBJECTIVE
  To determine the diagnostic performance of CT coronary angiography (CTCA) in detecting and excluding left main (LM) and/or three-vessel CAD ("high-risk" CAD) in symptomatic patients and to compare its discriminatory value with the Duke risk score and calcium score.
  
  
  METHODS
  Between 2004 and 2011, a total of 1,159 symptomatic patients (61 ± 11 years, 31 % women) with stable angina, without prior revascularisation underwent both invasive coronary angiography (ICA) and CTCA. All patients gave written informed consent for the additional CTCA. High-risk CAD was defined as LM and/or three-vessel obstructive CAD (≥50 % diameter stenosis).
  
  
  RESULTS
  A total of 197 (17 %) patients had high-risk CAD as determined by ICA. The sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratios of CTCA were 95 % (95 % CI 91-97 %), 83 % (80-85 %), 53 % (48-58 %), 99 % (98-99 %), 5.47 and 0.06, respectively. CTCA provided incremental value (AUC 0.90, P < 0.001) in the discrimination of high-risk CAD compared with the Duke risk score and calcium score.
  
  
  CONCLUSIONS
  CTCA accurately excludes high-risk CAD in symptomatic patients. The detection of high-risk CAD is suboptimal owing to the high percentage (47 %) of overestimation of high-risk CAD. CTCA provides incremental value in the discrimination of high-risk CAD compared with the Duke risk score and calcium score.
  
  
  CONCLUSIONS
  • Computed tomography coronary angiography (CTCA) accurately excludes high-risk coronary artery disease. • CTCA overestimates high-risk coronary artery disease in 47 %. • CTCA discriminates high-risk CAD better than clinical evaluation and coronary calcification.
authors.affiliation: Department of Radiology, Erasmus MC, Room Ca207a, s-Gravendijkwal 230, PO Box 2040, 3015 CE, Rotterdam, The Netherlands, a.dharampal@erasmusmc.nl.
authors.forename: Anoeshka S
authors.initials: AS
authors.lastname: Dharampal
authors.forename: Stella L
authors.initials: SL
authors.lastname: Papadopoulou
authors.forename: Alexia
authors.initials: A
authors.lastname: Rossi
authors.forename: W Bob
authors.initials: WB
authors.lastname: Meijboom
authors.forename: Annick
authors.initials: A
authors.lastname: Weustink
authors.forename: Marcel
authors.initials: M
authors.lastname: Dijkshoorn
authors.forename: Koen
authors.initials: K
authors.lastname: Nieman
authors.forename: Eric H
authors.initials: EH
authors.lastname: Boersma
authors.forename: Pim J
authors.initials: PJ
authors.lastname: de Feijter
authors.forename: Gabriel P
authors.initials: GP
authors.lastname: Krestin
mesh_terms: D002114:Calcinosis / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*